Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders
Article first published online: 2 NOV 2012
© 2012 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd
Acta Psychiatrica Scandinavica
Volume 127, Issue 5, pages 355–364, May 2013
How to Cite
Clinical responses to antidepressants among 1036 acutely depressed patients with bipolar or unipolar major affective disorders., , , , .
- Issue published online: 15 APR 2013
- Article first published online: 2 NOV 2012
- Manuscript Accepted: 13 SEP 2012
- Bruce J. Anderson Foundation
- McLean Private Donors Psychopharmacology Research Fund
- Lucio Bini Private Donors Mood Disorders Research Fund
- antidepressant response;
- bipolar disorder;
- major depressive disorder;
Whether responses to antidepressants differ in bipolar and unipolar depression remains unresolved.
We analyzed patient characteristics and outcomes of antidepressant treatment of 1036 depressed patients with bipolar-I or bipolar-II disorder, or unipolar major depression, using bivariate and multivariate methods and survival analysis, testing the hypothesis that responses would be superior in unipolar depression.
Antidepressants were given to 84.8% (878/1036) of depressed patients: 58.9% of 93 bipolar-I, 80.1% of 117 bipolar-II, and 91.3% of 668 unipolar disorder cases. The 158 not given antidepressants had more manias/year, spent more months in mania and depression, and were far more likely to receive mood stabilizers or antipsychotics long term. Improvement of HDRS21 depression ratings ranked: bipolar-II (69.6%) > bipolar-I (62.9%) > unipolar (57.9%; P < 0.0001), independent of initial illness severity. Responder rates (≥50% improved without switching) ranked: bipolar-II (77.0%) > bipolar-I (71.6%) > unipolar (61.7%; P < 0.0001). Remission rates (final HDRS < 7) ranked: 54.0%, 50.6%, and 40.8% respectively (P = 0.02); 67.5% remitted within 12 weeks of treatment. Survival-computed median time to remission (15.0 weeks, overall) was shortest for bipolar-II patients (10.7 weeks). The 3-month risk of switching into mania–hypomania ranked: bipolar-II (15.8%) > bipolar-I (8.60%) > unipolar (0.56%). Multivariate modeling found bipolar diagnosis, shorter latency to remission, more recent trial year, and fewer weeks depressed before treatment to be associated with greater percent improvement of HDRS ratings.
Selective use of antidepressants with or without mood stabilizers in non-agitated, depressed bipolar disorder patients for short periods was effective with moderate risk of potentially dangerous, manic mood elevation.